Gastrointestinal "crosses" - An indication for surgery

Background: We present our experience with a unique type of foreign body that was, specifically designed to arrest in its passage and cause perforation of the gastrointestinal tract. Study: Between 1994 and 1999, nine male prisoners from the same jail presented after ingestion of "crosses." A cross is constructed from the two halves of a standard paperclip that are tied together with a rubber band. The resulting construction is elastic: the two branches can be pulled to lie parallel, but they assume their original position once released. The cross, is wrapped into paper with its branches parallel and ingested. After release from the Wrapper, it "opens" and causes bowel perforations. Results: All patients underwent emergency surgery for foreign body removal and treatment of peritonitis. A total of 19 crosses were removed from the patients. Six (32%) were found in the stomach; five, in the duodenum (28%); three, in the jejunum and ileum (16%); and one, in the pylorus and colon. There was no morbidity or mortality. Conclusions: Foreign bodies of this type never pass distally. The ultimate key to success in the management of patients who have ingested crosses is emergency surgical intervention.